Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer
Authors: Sang-Yong Son, Hoon Hur, Woo Jin Hyung, Young-Kyu Park, Hyuk-Joon Lee, Ji Yeong An, Wook Kim, Hyoung-Il Kim, Hyung-Ho Kim, Seung Wan Ryu, Min-Chan Kim, Seong-Ho Kong, Gyu Seok Cho, Jin-Jo Kim, Do Joong Park, Keun Won Ryu, Young Woo Kim, Jong Won Kim, Joo-Ho Lee, Han-Kwang Yang, Sang-Uk Han, HyeSeong Ahn, Sang-Hoon Ahn, Jae-Moon Bae, Jung Min Bae, Sung Joon Bae, Cheul Su Byun, Yeon Soo Chang, Hyunjin Cho, In Cho, Minah Cho, Chang In Choi, Kyeong-Woon Choi, Seohee Choi, Seung-Ho Choi, Sung Il Choi, Yun-Suck Choi, Ho-Young Chung, Joo Won Chung, Jung Kee Chung, Bang Wool Eom, Sang Soo Eom, Dongyeop Ha, Man Ho Ha, Taekyung Ha, Dong-Seok Han, Sang-Moon Han, Se Wung Han, Yeon-Ju Huh, Sun-Hwi Hwang, You-Jin Jang, Ye Seob Jee, Chul Hyo Jeon, Gui-Ae Jeong, Inho Jeong, Oh Jeong, Sang-Ho Jeong, Sung-Ho Jin, Ji Hoon Jo, Kyong Hwa Jun, Bong Soo Jung, Do Hyun Jung, Mi-Ran Jung, Yoonju Jung, Dongbaek Kang, Ji Hoon Kang, So Hyun Kang, Amy Kim, Beom Su Kim, Chan Young Kim, Chang Hyun Kim, Chee Young Kim, Dae Hoon Kim, Dong Jin Kim, Dong -Wook Kim, Eun Young Kim, Ho-Goon Kim, Hyun Il Kim, In Ho Kim, Ji Hoon Kim, Jong-Han Kim, Jun Young Kim, Kap-Jung Kim, Ki Han Kim, Kwang Hee Kim, Kyoung Hwan Kim, Min Gyu Kim, Sa-Hong Kim, Sang Woon Kim, Se Won Kim, Seong-Gon Kim, Su Mi Kim, Sung Kim, Sung Geun Kim, Sung Soo Kim, Tae Han Kim, Yong Ho Kim, Yongil Kim, Yoo Min Kim, You Na Kim, Jeong Hyun Ko, Sung Chan Kong, In Gyu Kwon, Ji Hyoung Kwon, Oh Kyoung Kwon, Chang Min Lee, Han Hong Lee, Joong Ho Lee, Jun Ho Lee, Jun Hyun Lee, In Seob Lee, Kyung-Goo Lee, Moon-Soo Lee, Myung Jae Lee, Sang Eok Lee, Sang Ho Lee, Sang-Il Lee, Si Hak Lee, Se Youl Lee, Seung Soo Lee, Sol Lee, Yoontaek Lee, Seung Hyun Lim, Man-Sup Lim, Jae Seok Min, Woo-Kyun Mok, Young-Jae Mok, Yoon-Hwan Nam, Seung Jong Oh, Sung Don Oh, Sung Eun Oh, Sung Jin Oh, Cho Hyung Park, Dong Jin Park, Ji Ho Park, Ji Yeon Park, Ji Hyun Park, Jong-Min Park, Joong-Min Park, Ki Bum Park, Seong-Heum Park, Sungsoo Park, Yong Eun Park, Young Suk Park, Chulkyu Roh, Kun Ho Roh, Hoon Ryu, Seong Yeop Ryu, Ho Seok Seo, Jeong Eun Seo, Kyung Won Seo, Sang Hyuk Seo, Won Jun Seo, Jang Won Seon, Dong Gue Shin, Dong Woo Shin, Ho-Jung Shin, Tae Sung Sohn, Myoung Won Son, Taeil Son, Young-Gil Son, Geum Jong Song, Jeong Ho Song, Kyo Young Song, Sun-Kyo Song, Byoung Jo Suh, Yun-Suhk Suh, Ji-Young Sul, Choon Kyung Sung, Jun Young Yang, Han Mo Yoo, Moon-Won Yoo, Jeong-Hwan Yook, Hong Man Yoon, Ki Young Yoon, Sang Il Youn, Wansik Yu
Journal: JAMA Surgery (2022)

The long-term safety of laparoscopic distal gastrectomy for locally advanced gastric cancer (AGC) remains uncertain given the lack of 5-year follow-up results.To compare the 5-year follow-up results in patients with clinically AGC enrolled in the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-02 randomized clinical trial who underwent laparoscopic or open distal gastrectomy.The KLASS-02, a multicenter randomized clinical trial, showed that laparoscopic surgery was noninferior to open surgery for patients with locally AGC. The present study assessed the 5-year follow-up results, including 5-year overall survival (OS) and relapse-free survival (RFS) rates and long-term complications, in patients enrolled in KLASS-02. From November 21, 2011, to April 29, 2015, patients aged 20 to 80 years diagnosed preoperatively with locally AGC were enrolled. Final follow-up was on June 15, 2021. Data were analyzed June 24 to September 9, 2021.Patients were treated with R0 resection either by laparoscopic gastrectomy or open gastrectomy as the full analysis set of the KLASS-02 trial.Five-year OS and RFS rates, recurrence patterns, and long-term surgical complications were evaluated.This study enrolled a total of 1050 patients. A total of 974 patients were treated with R0 resection; 492 (50.5%) in the laparoscopic gastrectomy group (mean [SD] age, 59.8 [11.0] years; 351 men [71.3%]) and 482 (49.5%) in the open gastrectomy group (mean [SD] age, 59.4 [11.5] years; 335 men [69.5%]). In patients who underwent laparoscopic and open distal gastrectomy, the 5-year OS (88.9% vs 88.7%) and RFS (79.5% vs 81.1%) rates did not differ significantly. The most common types of recurrence were peritoneal carcinomatosis (73 of 173 [42.1%]), hematogenous metastases (36 of 173 [20.8%]), and locoregional recurrence (23 of 173 [13.2%]), with no between-group differences in types of recurrence at each cancer stage. The correlation between 3-year RFS and 5-year OS at the individual level was highest in patients with stage III gastric cancer (ρ = 0.720). The late complication rate was significantly lower in the laparoscopic than in the open surgery group (32 of 492 [6.5%] vs 53 of 482 [11.0%]). The most common type of complication in both groups was intestinal obstruction (13 of 492 [2.6%] vs 24 of 482 [5.0%]).The 5-year outcomes of the KLASS-02 trial support the 3-year results, which is the noninferiority of laparoscopic surgery compared with open gastrectomy for locally AGC. The laparoscopic approach can be recommended in patients with locally AGC to achieve the benefit of low incidence of late complications.ClinicalTrials.gov Identifier: NCT01456598.